clinical psychology - Key Question

Question 1

AO1 points on the clinical key question (Question)

Answer 1

How are mental health issues portrayed in the media?

Question 2

AO1 points on the clinical key question

Answer 2

• According to Time to Change, an organisation set up to influence public attitudes to mental health issues, the way MHDs is portrayed and reported in the media is incredibly powerful in educating and influencing the public.
• Signorielli (1989) found that 72% of characters with a mental illness depicted in prime-time TV were violent. Other studies found them to be unemployable or if employed, failing at work.
• A New Zealand study that conducted a thematic analysis of mental illness on TV found danger/aggression, unpredictability, incompetence and being childlike to be common themes, with the
  overall portrayal of mental illness as ‘outstandingly negative’.
• The media often portrays mental illness in an extremely negative way, e.g., The Silence of the Lambs, Seven, American Psycho, etc. When Frank Bruno, the heavyweight boxer, was admitted
  to a psychiatric unit, The Sun headline was initially, ‘Bonkers Bruno…’ but after much condemnation changed it to, ‘Sad Bruno’. Consider how other celebrities with mental health issues have been treated in the media, e.g., Brittany Spears, Paul Gascoigne.
• The media portrayal of murder committed by someone with mental disorder tends to lead the public to always associate the two, murder and mental illness; however, mental illness is only a
  factor in about 5% of ‘stranger murders’; people who killed complete strangers were less likely to have a history of mental illness, and were more likely to be people with drug and alcohol problems & this was likely to have played a part in their crime (Amos, 2001).
• The mental health charity MIND carried out a survey in 1996 into media portrayals of mental illness and found that 60% of participants with a mental disorder felt that the coverage of mental illness was unfair, and that it had affected how others responded to them.
• In 1997, The Health Education Authority found that more than half the media references to mental health were linked to violence and criminality; another survey found that 40% of the UK public linked mental health to violence.
• The negative, and often highly inaccurate, sensationalised coverage and depiction of mental illness, arguably leads to the increasing stigmatisation of mental illness, with the result that people with mental disorders are reluctant to admit they have mental disorders for fear of others’ reactions – this is not so much the case with physical disorders.
• As a result of negative media stereotypes of mental illness people suffering from mental disorders attract considerable prejudice.
• A study by Skinner et al. (1995) surveyed US college students
  on their attitudes towards EX-drug addicts, EX-convicts and EX-psychiatric patients, asking about, e.g., their social functioning, romantic relationships and work. Unfortunately, like the Philo et al. study described below, there was considerable stigma attached to mental illness.
• In the Skinner study with regard to social functioning, romantic relationships and work ex-psychiatric patients were judged better than ex-convicts but worse than ex-drug addicts (1. ex-drug addicts: 2. ex-psychiatric patients: 3. ex-convicts).
• Other research has shown that stigmatisation varies between
  disorders and is related to beliefs about how controllable the disorders are and the likelihood of improvement (Corrigan et al., 2000).
• This stigmatisation can cause much distress and potentially
  exacerbate the condition. The negative label of mental illness may lead individuals suffering from mental disorders to become more withdrawn and socially isolated.
• A study by Philo et al. (1994) examined the content of local and national media in Scotland and their coverage of mental health issues during the month of April 1993 (content analysis). The results showed strong evidence for the role of the media in perpetuating negative stereotypes of people with mental disorders.
• The study found that 66% of all incidents (including factual and fictional cases) covering mental health issues involved accounts of violence. A further 13% showed people with mental health problems harming themselves. Overall, only 18% of fictional and factual incidents were judged to give sympathetic coverage of mental health issues.
• The researchers then used questionnaire and interviews to try and elicit viewers’ responses to the coverage of mental health issues.
• With the exception of those who had personal experience of
  people with mental health problems, e.g., through family or work, viewers reported negative stereotyped/typical views of the sufferers of mental disorders.

Question 3

AO2 Application points on the clinical key question

Answer 3

• The mass media is the primary source for many people about MHDs, yet it contains misinformation, misrepresentation and inaccurate use of terminology.
• It presents conventions on mental health issues through consistent and recurring themes reflecting negative and biased messages, ideas and uninformed stereotypes.
• For e.g. Diefenbach (1997) analysed the content of prime-time TV in the US over a 2-week period and found 32% of programmes had at least one character with a MHD and that these characters were portrayed as 10x more violent than general TV characters, with 50% of violent offences being committed by someone with a MHD.
• Characters with MHDs were depicted as 10-20x more violent than mentally ill people in the general US population.
• Granello and Pauley (2000) found that intolerant attitudes towards those with MHDs were significantly and positively correlated with the amount of TV watched (N.B., correlations & cause and effect; TV viewing may be linked to other causal factors, lower SES, or educational ability, higher RWA etc.)
• In a content analysis of 50 years of Hollywood films & their presentation of mental illness, Lopex Levers (2001) found that those with MHDs were often portrayed as passive, pathetic or comical, most frequently as dangerous – requiring restraints or invasive procedures.
• This portrayal does not reflect the reality of mental illness, rather a lazy, stereotypical view of mental illness used in film iconography.
• Mentally ill people are more likely to be the victims of violence than perpetrators, and much more likely to themselves than others, however, media depictions of MHDs tend to ignore this and depict an alternative ‘reality’ which is not supported by the evidence.
• Nevertheless, this has a powerful impact on the public’s
  perceptions of mental illness; a third of the public still believes that someone with a MHD is prone to violence (Attitudes to Mental Health, 2013)
• You could look at other media stereotypes, e.g., would we watch martial arts films to learn about Asian behaviour; or watch gangster films to learn about Italians? Why then watch films about serial killers and assume they give any insight into mental illness and the experience of those who suffer from mental disorders.
• Bandura has developed SLT and shown how we model significant others and are influenced by media images, so negative stereotypes of mental illness, associating it with violence & crime, might influence how we react to people with mental disorders, possibly leading to discrimination and prejudice towards those with mental disorders.
• Seeing unrealistic models of MHDs and seeing how characters react to an unrealistic depiction of mental illness, may influence how people react to individuals with real MHDs.
• This may affect how others react to people with MHDs, leading to mentally ill people being labelled, ostracised, self-fulfilling prophecy etc.
• Self-fulfilling prophecy: unrealistic media depictions may lead to a negative labels being applied to people with MHDs, stigmatising people with MHDs, affecting how others react to individuals with MHDs, and affecting how the mentally ill person interprets their own behaviour and symptoms, i.e., internalising the label.
• The negative stigma attached to MHDs may lead to a reluctance to seek a diagnosis, meaning that treatment is not sort until the illness is quite advanced; it might lead to increased absenteeism, discrimination in the workplace and social isolation.
• This itself will negatively impact on the prognosis of the mental disorder, as the mentally ill person withdraws themselves from others due to the stigma, the label that they may be dangerous, which they themselves might mistakenly believe.
• In a review of the depiction of MHDs for the APA (Tartakovsky, 2009), it was said that the media portrays depression as a chemical imbalance (along with other types of MHDs).
• In some respects this might be accurate and positive, i.e., it implies the individual has no control over their condition, as it is chemical imbalance in the brain which they cannot help.
• However, this may also serve to oversimplify MHDs; chemotherapy is just one form of treatment, not always successful, and may be affected by the placebo effect and publication bias.
• There is not necessarily a ‘magic bullet’ for mental illness and people with MHDs may often have a protracted battle for mental illness and recovery may be a long, incomplete process; the reality of diagnosis, treatment and prognosis is not generally realistically depicted in the media, due to the constraints of storytelling.

Question 4

AO2 Application points on the clinical key question (Continuation)

Answer 4

• Some research suggests that giving people a medical cause for a MHD, such as schizophrenia, will reduce the blame associated with the disorder but does not change the prejudice linked to it, such as unpredictability and danger.
• In fact it might make people more likely to avoid those with the disorder in the future, as there is a sense that the schizophrenic individual will not be able to control their potentially dangerous thoughts and behaviour (Penn et al., 2003).
• In a content analysis of articles related to OCD, Wahl (2000) found them to be mostly accurate, although some did link with OCD with stalking behaviour inaccurately.
• The media often portrays depression as a predominately female disorder; although there is some statistical support for this, this may again oversimplify the issue.
• Women may be more likely to be diagnosed due to the gender stereotype of depression and because of this may be more likely to seek a clinical diagnosis than men; women may be modelling an adverse reaction as they are presented with this in the media, or they are being labelled as depressive more and internalising that label – perhaps due to the way the media models depression (as a female prone condition).
• The stigma attached to a diagnosis of a MHD, partly to the way the media portrays mental illness, may mean people do not seek a diagnosis/intervention early enough, having a negative
  effect on prognosis.
• Early intervention is often very beneficial in MHDs. Research by Brown and Bradley (2002) in the US suggests that 25% of people with a MHD do not seek treatment and they suggest that stigma is a primary cause of this.
• Rosenhan’s classic study (1973) shows how behaviour is often judged within a particular context; normal behaviour can be misrepresented as abnormal behaviour if a label of mental illness has been applied to an individual (i.e., a sign of mental illness rather than eccentricity, individuality etc.).
• If our view of mental illness is that it is entirely negative, frightening,
  dangerous and violent, because the only examples of people with MHDs we have seen are in the media (as we have no direct experience), then those with this label/diagnosis (mentally ill) will be judged as frightening, dangerous, violent etc. whether they are or not.
• If the media judges certain types of behaviour as indicative of mental illness & labels the behaviour accordingly, we may judge people who behave in this way as mentally ill.
• However, the media may simply be expressing what are current social norms & values, not what is actually sign of mental illness, e.g., materialism/consumerism, sexual behaviour – see Thomas Szasz, R D Laing, Jon Ronson The Psychopath Test, Jeremy Kyle, Channel 4/5 documentaries.
• The stigma attached to MHDs may lead to social isolation and so a lack of opportunities for positive reinforcements that may be gained from social interaction with others; such social interactions may act as a protective factor reducing the severity of MHD symptoms.
• Positive social interactions may also provide the motivation to comply with treatment and not give up.
• Media portrayal of mental illness is often negative and misrepresents mental illness; however, positive media representations of MHDs can ameliorate some of the negative attitudes and stereotypes that surround mental illness.
• Social learning theory can be applied here, i.e., exposure to role models that tell a more positive story about mental illness, e.g., high status individuals, celebrities who are coping well with their MHD, storylines where characters can have a good prognosis after a diagnosis of a MHD.
• The media can play a part in ‘normalising’ rather than stigmatising mental illness: 1 in 4 people will experience some form of mental illness – the media might reflect this and the experience of mental illness more accurately and sympathetically.
• As a result mental illness might be less stigmatising and less frightening for people. E.g., recent research into public attitudes to MHDs found a significant decrease in intolerance in recent years (Attitudes to Mental Health, 2013).
• Analysing 18 years of survey data into public perception towards
  mental health, this report also found that attitudes (particularly women’ attitudes) to MHDs have improved significantly since 1994.

Question 5

AO2 Application points on the clinical key question (Conclusions)

Answer 5

• Society, including the media, has an ethical responsibility to be truthful and not to label any group unfairly and negatively, which may lead to negative prejudice, or cause any particular group in our society to be negatively discriminated against causing that group to be mistreated or misjudged.
• Some might argue that the role of the media is not necessarily to be a public information provider or educator, that is the government’s job, it is to entertain.
• The media could consider explaining more about schizophrenia, depression etc., e.g., the different types, different outcomes.
  -The media could consider not relentlessly focusing on the negative aspects of mental illness, but on recovery & how successful
  medication & treatment can be.
• Depression is a very common mental disorder & affects a wide range of people, may be greater awareness of this, i.e., that mental
  illness does not just affect lower SES people, but a vast range of people.
• Conversely the media might consider why lower SES people
  are more affected by mental illness.
• It is thought that 1 in 4 people will suffer some form of mental health problem at some point – the media often ignores this and that
  depression may become a bigger killer than heart disease in a few decades time.
• Bandura has developed SLT and shown how we model significant others and are influenced by media images, so negative stereotypes of mental illness, associating it with violence and crime, might influence how we react to people with mental disorders, possibly leading to discrimination and prejudice towards those with mental disorders.
• Self-fulfilling prophecy, stereotyping, stigmatising and labelling are also influenced by media depiction of MHDs.
• There are positive portrayals of mental illness and illustrate why they are more accurate, e.g., A Beautiful Mind.